Healthcare Provider Details

I. General information

NPI: 1922284439
Provider Name (Legal Business Name): MERCY FITZGERALD CRNA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

PO BOX 827675
PHILADELPHIA PA
19182-7675
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4000
  • Fax: 856-423-0823
Mailing address:
  • Phone: 856-423-7700
  • Fax: 856-423-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: GINA R CAMERON
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 610-567-5148